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Field Triage Reduces the Incidence and Mortality of Ischaemic Cardiogenic Shock in Patients with Acute Myocardial Infarction
Abstracts
reduce door to balloon (DTB) time in STEMI. Shorter DTB times are associated with reduced mortality. The main barrier to implementing ED CCL activation is concern of inappropriate activation of the CCL. Aim: To compare false positive rates of suspected STEMI patients undergoing emergency coronary angiography by cardiology verses senior ED activation of the CCL. Methods: All patients undergoing emergency cardiac catheterisation for STEMI from 2007 to 2009 were analysed. False positive rates were compared before and after implementing a protocol enabling independent ED activation of the CCL (2007–2008 vs. 2009). Some patient characteristics required ED to communicate with cardiology prior to CCL activation (elderly, borderline ECG changes, out of hospital arrest, LBBB, significant co-morbidities). Patient files, ECGs, coronary angiograms and left ventriculograms were reviewed in all patients undergoing emergency angiography without percutaneous coronary intervention to determine diagnosis, management and cause of the false positive cases. Results: Cardiology 2008–2009 (n = 150) Primary PCI Medical management Surgery False positive
118 (79%) 11 (7%) 3 (2%) 18 (12%)
Methods: In a retrospective analysis of our AMI database encompassing 5-year data, we identified 359 consecutive FT and 1314 ET patients admitted with AMI. ICS was defined as the in-hospital use of inotropes. To compare the incidence of ICS and mortality in the two groups we used the chi-square test. Results: In-hospital mortality of FT and ET patients were 12/359 (3.3%) and 80/1314 (6.0%), respectively. The in-hospital mortality rate of the FT and ET groups who did not develop ICS was 1.8% in both groups (FT 6/328 vs ET 20/1100 patients). In the FT group 31 patients developed ICS (8.6%) versus 214 patients in the ET group (16%, P < 0.0003). Six patients in the FT group versus 60 patients in the ET group with ICS died in-hospital (19% vs 28%; P < 0.02). The door-to-balloon time was 40 ± 28 min for the FT and 89 ± 138 min for the ET groups, respectively. Conclusion: FT confers a significant survival benefit over ET. The 45% overall mortality benefit of the FT patients is mainly driven from lower frequency of ICS (by 47%) and a significantly decreased mortality rate (by 32%) in patients who develop cardiogenic shock.
ED 2009 (n = 84) 70(83%) 4 (5%) 1 (1) 9 (11%) (NS)
Causes of false positives: Chest pain of unclear cause with either early repolarisation of ST segments or LBBB (63%, 7/27). Takotsubo cardiomyopathy (22%, 6/27), myo/pericarditis (11%, 3/27) and pulmonary embolism (5%, 1/27). Conclusion: False positive rates in patients undergoing emergency angiography for suspected STEMI is not increased with a controlled system of emergency physician activation of the cardiac catheterisation laboratory. doi:10.1016/j.hlc.2010.06.975 309 Field Triage Reduces the Incidence and Mortality of Ischaemic Cardiogenic Shock in Patients with Acute Myocardial Infarction A. Nojoumian ∗ , S. Buchholz, C. Yao-Yu, S. Soo Hoo, A. Loxton, R. Bhindi, P. Hansen, H. Rasmussen, G. Nelson, M. Ward Department of Cardiology, Royal North Shore Hospital, Australia Background: The main cause of in-hospital mortality with acute myocardial infarction is ischemic cardiogenic shock (ICS). We have previously shown that field triage (FT) of acute myocardial infarction (AMI) patients is associated with smaller infarct size and lower mortality than Emergency triage (ET). We compared the incidence and mortality of ischemic cardiogenic shock in FT and ET patients and correlated any differences with door-toballoon time.
S131
Total
ETAMI SALAMI
359 1314
Inotrope used (%)
31 (8.6) 214 (16.2)
In-hospital mortality inotrope (%)
In-hospital mortality no inotrope (%)
6/31 (19) 60/214 (28)
6/328 (1.8) 20/1100 (1.8)
doi:10.1016/j.hlc.2010.06.976 310 First Australian Experience with the Amplatzer Left Atrial Appendage Occlusion System: Royal Perth Hospital 2010 T. Gattorna 1,∗ , V. Paul 1 , R. Clugston 1 , M. Ferman 2 1 Royal
Perth Hospital, Australia of Western Australia, Australia
2 University
Atrial fibrillation significantly increases the risk of stroke, with most thrombi arising from the left atrial appendage (LAA). Oral anticoagulation with vitamin K antagonists greatly reduces this risk of stroke, but providing safe and effective therapy is challenging and may be contraindicated in patients despite their stroke risk. LAA occlusion devices provide a new nonpharmacological alternative for stroke risk reduction in patients with non-valvular atrial fibrillation. The three devices currently in use include the PLAATO system, the WATCHMAN filter system and the Amplatzer system. We describe the initial experience of percutaneous closure of the LAA at Royal Perth Hospital using the Amplatzer system in 6 patients with non-valvular atrial fibrillation. The system involves the placement of a dual mechanism composed of a flexible, braided Nitinol mesh, consisting of a lobe and disc, connected by a compliant, articulating waist. The lobe conforms to the inner wall of the LAA and the disc occludes the LAA orifice. The procedure is performed under fluoroscopic and transoesphageal guidance. The device size in our series varied from 18 mm to 28 mm and the mean duration of procedure
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
reduce door to balloon (DTB) time in STEMI. Shorter DTB times are associated with reduced mortality. The main barrier to implementing ED CCL activation is concern of inappropriate activation of the CCL. Aim: To compare false positive rates of suspected STEMI patients undergoing emergency coronary angiography by cardiology verses senior ED activation of the CCL. Methods: All patients undergoing emergency cardiac catheterisation for STEMI from 2007 to 2009 were analysed. False positive rates were compared before and after implementing a protocol enabling independent ED activation of the CCL (2007–2008 vs. 2009). Some patient characteristics required ED to communicate with cardiology prior to CCL activation (elderly, borderline ECG changes, out of hospital arrest, LBBB, significant co-morbidities). Patient files, ECGs, coronary angiograms and left ventriculograms were reviewed in all patients undergoing emergency angiography without percutaneous coronary intervention to determine diagnosis, management and cause of the false positive cases. Results: Cardiology 2008–2009 (n = 150) Primary PCI Medical management Surgery False positive
118 (79%) 11 (7%) 3 (2%) 18 (12%)
Methods: In a retrospective analysis of our AMI database encompassing 5-year data, we identified 359 consecutive FT and 1314 ET patients admitted with AMI. ICS was defined as the in-hospital use of inotropes. To compare the incidence of ICS and mortality in the two groups we used the chi-square test. Results: In-hospital mortality of FT and ET patients were 12/359 (3.3%) and 80/1314 (6.0%), respectively. The in-hospital mortality rate of the FT and ET groups who did not develop ICS was 1.8% in both groups (FT 6/328 vs ET 20/1100 patients). In the FT group 31 patients developed ICS (8.6%) versus 214 patients in the ET group (16%, P < 0.0003). Six patients in the FT group versus 60 patients in the ET group with ICS died in-hospital (19% vs 28%; P < 0.02). The door-to-balloon time was 40 ± 28 min for the FT and 89 ± 138 min for the ET groups, respectively. Conclusion: FT confers a significant survival benefit over ET. The 45% overall mortality benefit of the FT patients is mainly driven from lower frequency of ICS (by 47%) and a significantly decreased mortality rate (by 32%) in patients who develop cardiogenic shock.
ED 2009 (n = 84) 70(83%) 4 (5%) 1 (1) 9 (11%) (NS)
Causes of false positives: Chest pain of unclear cause with either early repolarisation of ST segments or LBBB (63%, 7/27). Takotsubo cardiomyopathy (22%, 6/27), myo/pericarditis (11%, 3/27) and pulmonary embolism (5%, 1/27). Conclusion: False positive rates in patients undergoing emergency angiography for suspected STEMI is not increased with a controlled system of emergency physician activation of the cardiac catheterisation laboratory. doi:10.1016/j.hlc.2010.06.975 309 Field Triage Reduces the Incidence and Mortality of Ischaemic Cardiogenic Shock in Patients with Acute Myocardial Infarction A. Nojoumian ∗ , S. Buchholz, C. Yao-Yu, S. Soo Hoo, A. Loxton, R. Bhindi, P. Hansen, H. Rasmussen, G. Nelson, M. Ward Department of Cardiology, Royal North Shore Hospital, Australia Background: The main cause of in-hospital mortality with acute myocardial infarction is ischemic cardiogenic shock (ICS). We have previously shown that field triage (FT) of acute myocardial infarction (AMI) patients is associated with smaller infarct size and lower mortality than Emergency triage (ET). We compared the incidence and mortality of ischemic cardiogenic shock in FT and ET patients and correlated any differences with door-toballoon time.
S131
Total
ETAMI SALAMI
359 1314
Inotrope used (%)
31 (8.6) 214 (16.2)
In-hospital mortality inotrope (%)
In-hospital mortality no inotrope (%)
6/31 (19) 60/214 (28)
6/328 (1.8) 20/1100 (1.8)
doi:10.1016/j.hlc.2010.06.976 310 First Australian Experience with the Amplatzer Left Atrial Appendage Occlusion System: Royal Perth Hospital 2010 T. Gattorna 1,∗ , V. Paul 1 , R. Clugston 1 , M. Ferman 2 1 Royal
Perth Hospital, Australia of Western Australia, Australia
2 University
Atrial fibrillation significantly increases the risk of stroke, with most thrombi arising from the left atrial appendage (LAA). Oral anticoagulation with vitamin K antagonists greatly reduces this risk of stroke, but providing safe and effective therapy is challenging and may be contraindicated in patients despite their stroke risk. LAA occlusion devices provide a new nonpharmacological alternative for stroke risk reduction in patients with non-valvular atrial fibrillation. The three devices currently in use include the PLAATO system, the WATCHMAN filter system and the Amplatzer system. We describe the initial experience of percutaneous closure of the LAA at Royal Perth Hospital using the Amplatzer system in 6 patients with non-valvular atrial fibrillation. The system involves the placement of a dual mechanism composed of a flexible, braided Nitinol mesh, consisting of a lobe and disc, connected by a compliant, articulating waist. The lobe conforms to the inner wall of the LAA and the disc occludes the LAA orifice. The procedure is performed under fluoroscopic and transoesphageal guidance. The device size in our series varied from 18 mm to 28 mm and the mean duration of procedure
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268